Provider Demographics
NPI:1124409396
Name:KV TOTAL NUTRITION LLC
Entity Type:Organization
Organization Name:KV TOTAL NUTRITION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:VERA
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:512-590-1585
Mailing Address - Street 1:1011 1ST ST SE
Mailing Address - Street 2:APT 914
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20003-3392
Mailing Address - Country:US
Mailing Address - Phone:512-590-1585
Mailing Address - Fax:
Practice Address - Street 1:1011 1ST ST SE
Practice Address - Street 2:APT 914
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20003-3392
Practice Address - Country:US
Practice Address - Phone:512-590-1585
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-14
Last Update Date:2015-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDI100000720133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty